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Short, Full-Dose Adjuvant Chemotherapy in High-Risk Adult Soft Tissue Sarcomas: A Randomized Clinical Trial From the Italian Sarcoma Group and the Spanish Sarcoma Group

2012; Lippincott Williams & Wilkins; Volume: 30; Issue: 8 Linguagem: Inglês

10.1200/jco.2011.37.7218

1527-7755

Alessandro Gronchi, S. Frustaci, Mario Mercuri, Javier Martín‐Broto, Antonio López‐Pousa, Paolo Verderio, Lidia Mariani, Pinuccia Valagussa, Rosalba Miceli, Silvia Stacchiotti, Angelo Paolo Dei Tos, Antonino De Paoli, Alessandra Longhi, Andrés Poveda, Vittorio Quagliuolo, Alessandro Comandone, Paolo G. Casali, Piero Picci,

Cardiac tumors and thrombi

Purpose A previous randomized clinical trial by the Italian Sarcoma Group (ISG) had shown a survival benefit of adjuvant chemotherapy (CT) in high-risk extremity soft tissue sarcoma (STS). However, the dose-intensity of the last two cycles was suboptimal. We then undertook a multicentric international phase III study to compare three and five cycles of the same CT. Patients and Methods Patients were randomly assigned either to receive three cycles of preoperative CT with epirubicin 120 mg/m 2 and ifosfamide 9 g/m 2 and granulocyte colony-stimulating factor (arm A) or to receive the same three cycles of preoperative CT followed by two further cycles of postoperative CT (arm B). Noninferiority of the primary end point, overall survival (OS), was assessed by the CI of the hazard ratio (HR; arm A/arm B) obtained from the Cox model. Results Between January 2002 and April 2007, 328 patients were recruited (164 patients in each arm). At a median follow-up of 63 months (interquartile range, 49 to 77 months), 100 deaths were recorded, 49 in arm A and 51 in arm B. Five-year OS probability was 0.70 for the entire group of patients (0.68 in arm A and 0.71 in arm B). The HR of arm A versus arm B was 1.00 (90% CI, 0.72 to 1.39). Conclusion In this population of patients with high-risk localized STS, three cycles of full-dose preoperative CT were not inferior to five cycles. The outcome compares favorably with the expected survival of patients with high-risk STS and was superimposable on the CT arm of the previous ISG trial.